Healthcare Provider Details

I. General information

NPI: 1477472173
Provider Name (Legal Business Name): GEM SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22401 FOSTER WINTER DR
SOUTHFIELD MI
48075-3724
US

IV. Provider business mailing address

43422 W OAKS DR STE 301
NOVI MI
48377-3300
US

V. Phone/Fax

Practice location:
  • Phone: 313-889-3456
  • Fax: 313-429-1021
Mailing address:
  • Phone: 313-889-3456
  • Fax: 313-429-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAKE RYAN MOVITZ
Title or Position: OWNER
Credential: MD
Phone: 313-889-3456